Basic Information
| Provider Information | |||||||||
| NPI: | 1427576123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITMIRE | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | WADE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 444 | ||||||||
| Address2: | |||||||||
| City: | MURPHY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 289060444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288370071 | ||||||||
| FaxNumber: | 8288375309 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROBBINSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287718409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284796466 | ||||||||
| FaxNumber: | 8284799267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2017 | ||||||||
| LastUpdateDate: | 09/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C008677 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.